Mount Carmel Health Partners Clinical Guidelines Low Back Pain

Oswestry Low Back Pain Disability Questionnaire Instructions: This questionnaire has been designed to give us information as to how your back or leg pain is affecting your ability to manage in everyday life. Please answer by checking ONE box in each section for the statement which best applies to you. We realize you may consider that two or more statements in any one section apply but please just shade out the spot that indicates the statement which most clearly describes your problem. Section 1— Pain intensity Section 6— Standing I have no pain at the moment I can stand as long as I want without extra pain The pain is very mild at the moment I can stand as long as I want but it give me extra pain The pain is moderate at the moment Pain prevents me from standing for more than one hour The pain isfairly severe at the moment Pain prevents me from standing from more than 30 minutes The pain is the worst imaginable at the moment Pain prevents me from standing from more than 10 minutes Pain prevents me from standing at all Section 2— Personal care (washing, dressing etc.) Section 7— Sleeping I can look after myself normally without causing extra pain I can look after myself normally but it causes extra pain My Sleep is never disturbed by pain It is painful to look after myself and I am slow and careful My sleep is occasionally disturbed by pain I need some help but manage most of my personal care Because of pain I have less than 6 hours sleep I need help every day in most aspects of self-care Because of pain I have less than 4 hours sleep I do not get dressed, I wash with difficulty and stay in bed Because of pain I have less than 2 hours sleep Pain prevents me from sleeping at all Section 3— Lifting Section 8— Sex life (if applicable) I can lift heavy weights without extra pain I can lift heavy weights but it gives extra pain My sex life is normal and causes no extra pain Pain prevents me from lifting heavy weights off the floor, but I My sex life is normal but causes some extra pain can manage if they are conveniently placed, eg. On a table My sex life is nearly normal but is very painful I can lift very light weights My sex life is severely restricted by pain I cannot lift or carry anything at all My sex life is nearly absent because of pain Pain prevents any sex life at all Section 4— Walking Pain does not prevent me walking any distance Section 9— Social life Pain prevents me from more the one mile My social life is normal and gives me no extra pain Pain prevent me from walking more than 1/2 mile My social life is normal but increases the degree of pain Pain prevents me from walking more than 100 yards Pain has no significant effect on my social life apart from limiting I can only walk using a stick or crutches my more energetic interests e.g., sport I am in bed most of the time Pain has restricted my social life and I do not go out as often Pain has restricted my social life to my home Section 5— Sitting I have no social life because of pain I can sit in any chair as long as I like I can only sit in my favorite chair as long as I like Pain prevents me sitting more than one hour Pain prevents me from sitting more than 30 minutes Pain prevents me from sitting more than 10 minutes Pain prevents me from sitting at all Section 10— Travelling I can travel anywhere without pain I can travel anywhere but it gives me extra pain Pain is bad but I manage journeys over two hours Pain restricts me to journeys of less than one hour Pain restricts me to short necessary journey under 30 minutes Pain prevents me from travelling except to receive treatment Low Back Pain - 4

Mount Carmel Health Partners Clinical Guidelines Low Back Pain | Page 4